Update on (Adult) Social Care and Integration with the NHS

1. Update on (Adult) Social Careand Integration with the NHS BVSC 17 December 2013 Health and Social Care Network Alan Lotinga

2. Core Aim and target groups • To deliver on safety and quality of life for those who need additional support or services: • All of whom have “disability” or have become “disabled” through age • Are in a situation of risk • And those who need both services and the costs of those services met: • Those who meet the above and are poor

3. Five daily living tests of eligibility • Assistance with: • Getting out of bed • Getting dressed • Going to the toilet • Feeding self • Washing yourself At a substantial and critical level of need

4. Only get local authority funding if: • Less than £23k of capital. • Insufficient income to cover economic cost of service.

5. National Outcomes framework • Enhancing Quality of life for people with care and support needs • Delaying and reducing the need for care and support • Ensuring people have a positive experience of care • Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm

6. Informed choice Prediction and prevention More funds diverted to enablement Fewer users require an IB Income maximisation Enablement Benefit dependencies Gate keeping USERS IBs Market shaping Gate keeping Gate keeping Gate keeping

7. A Few Big Issues to add! • Health and Wellbeing Board, Strategy and 3 top local priority areas. • Leadership on Public Health • Budget pressures! £29m extra budget cut for A+C next year proposed. • Children’s Social Care • Emergency care and winter pressures • Care Bill – who pays for care, Carers, “asset-based” assessments, etc. • Integration with the NHS…..

8. Launched June 2013, NHS England/LGA guidance issued in Oct and Nov, awaiting more detail around performance element • £3.8 billion joint pooled fund to be spent locally on health and social care to promote closer integration and improve outcomes in 2015/16 • Including £354m capital funding, with some £220m of DFG. • Mostly from existing NHS budgets and Section 256 funding transfers • Estimating about £80m for Birmingham • Not just for older adults, but not overly clear in the guidance • HW Boards expected to sign off 2 and 5 year plans in Feb 2014. • Encouraged to extend the scope of the plan and pooled budgets. • Expected to work with providers, especially Acute Hospitals, to help manage transition to new patterns of provision. • Performance element. National Integration Transformation Fund (ITF)

9. ITF – Some local ingredients to build on in Birmingham • Need to use our combined experience and expertise from past and present joint working to create required at scale Birmingham plans • Joint commissioning for learning disability and mental health – established largest UK pooled budget. Now in its 4th year. £300m per annum. • Children’s Strategic Partnership Board working towards joint commissioning arrangements of at least £50m per annum. • Older Adults Integration Programme currently evaluating potential for joint arrangements – could be as much as £600m per annum. Focussing on 6 themes to roll out citywide ie 7 day working, local MDTs, intermediate care, single point of access, front of A+E working, discharge to assess. • 75% data matching on NHS number. • HWB Strategy “plan on a page”.

10. Payment for Performance • More guidance expected mid December • Measures still being agreed, but the 4 most likely are – emergency hospital admissions, effectiveness of reablement, user experience, and delayed transfers of care • Some measures will be available for April 2015 for first performance payment, but impact not known on most of plan areas until near end of 15/16 • And remember this isn’t new money, and we already have a fragile health, care and support system……

11. National Integration Pioneers – learning from these • 14 areas announced as first wave pioneers on 1st November • Visit www.gov.uk/government/news/integration-pioneers-leading-the-way-for-health • Norman Lamb, Care and Support Minister:- “Too often care is uncoordinated, leaving too many people needlessly entering the revolving door of their local A&E again and again, because somewhere in the system their care has broken down.”